Healthcare Provider Details

I. General information

NPI: 1205145224
Provider Name (Legal Business Name): SYDNEY JANE OSBORNE DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2010
Last Update Date: 10/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12910 TOTEM LAKE BLVD NE STE 105
KIRKLAND WA
98034-2901
US

IV. Provider business mailing address

700 DEBORAH RD STE 190
NEWBERG OR
97132-3075
US

V. Phone/Fax

Practice location:
  • Phone: 425-823-8631
  • Fax:
Mailing address:
  • Phone: 503-546-6392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6375
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: